Individual
MR. LANCE KONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215
(414) 649-6000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
117
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100080994
—
WI
Enumeration date
06/11/2018
Last updated
08/19/2024
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